高流量鼻导管在早产儿呼吸暂停中有效性和安全性的Meta分析

doi:10.3969/j.issn.1002-1949.2018.11.013

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摘要目的系统评价高流量鼻导管（high flow nasal cannula， HFNC)辅助通气应用于早产儿呼吸暂停(AOP)的治疗效果。方法计算机检索PubMed、EMbase、The Cochrane Library、Web of Science、CBM、CNKI和万方中文数据库中关于HFNC辅助通气应用在早产儿AOP治疗的随机对照试验（randomized controlled trial, RCT）及半随机对照试验（quasi-randomized control trial, q-RCT），检索时限截至2018-01。由2位评价员按纳入与排除标准独立筛选文献和提取资料并评价偏倚风险后，采用Stata 12.0软件进行Meta分析。结果 9项RCT和1项q-RCT纳入本研究，共计769例患者。Meta分析结果显示，与鼻塞持续气道正压通气（nasal continuous positive airway pressure, NCPAP）组比较，HFNC组可降低鼻损伤发生率［OR=0.30, 95%CI（0.19,0.48）, P＜0.05］、气漏综合征发生率［OR=0.41, 95%CI（0.19,0.88）, P=0.022］，以及缩短总用氧时间［SMD=-0.51, 95%CI（-1.00,-0.02）, P=0.040］，但在有效率［OR=1.15，95%CI（0.89,1.48），P=0.275］、插管率［OR=0.69, 95%CI（0.42,1.13）, P=0.140］、无创通气时间［SMD=-0.35, 95%CI（-1.02,0.31）, P=0.297］和其他并发症方面差异无统计学意义。结论与NCPAP比较，HFNC能明显减少鼻损伤发生率以及气漏综合征发生率，但在有效性以及其他并发症发生率方面仍需大量RCT进一步对比研究。

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	刘晶晶
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	刘漪珊
	薛鸿
	岳瀚逊
	刘健
	杨克虎

关键词 ：高流量鼻导管（HFNC）, 早产儿, 呼吸暂停(AOP), Meta 分析

通讯作者: 刘健（1970-），男，博士，主任医师，教授，硕士生导师，副院长，E-mail：medecinliu@sina.com。

作者简介: 刘晶晶（1993-），女，硕士研究生，E-mail：945388473@qq.com。

引用本文:

刘晶晶，朱磊，刘漪珊，薛鸿，岳瀚逊，刘健，杨克虎. 高流量鼻导管在早产儿呼吸暂停中有效性和安全性的Meta分析[J]. 中国急救医学, 2018, 38(11): 986-990.
iu Jing-jing, Zhu Lei, Liu Yi-shan, Xue Hong,Yue Han-xun, Liu Jian, Yang Ke-hu. The efficacy and safety of high flow nasal cannula in preterm neonatal apnea：a meta-analysis. Chinese Journal of Critical Care Medicine, 2018, 38(11): 986-990.

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http://www.cnemergency.org.cn/CN/10.3969/j.issn.1002-1949.2018.11.013 或 http://www.cnemergency.org.cn/CN/Y2018/V38/I11/986

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